Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: clinical outcomes in elderly patients.

Objectives: To evaluate the outcome in elderly patients (≥ 75 years) undergoing elective aortic arch surgery with the aid of selective antegrade cerebral perfusion (SACP) and moderate hypothermic circulatory arrest (HCA).

Methods: A series of 95 patients ≥ 75 years (median age 77 years, median EuroSCORE 28) undergoing elective aortic arch surgery with SACP and moderate HCA were analysed with regard to clinical outcome. Risk factors for serious adverse events (mortality, neurological injury) were determined.

Results: Sixty-three patients (66%) underwent ascending aorta and hemiarch replacement, whereas 32 patients (34%) underwent ascending aorta and total arch replacement. Isolated arch replacement was rare. Additionally, 27% of patients underwent aortic valve replacement and 26% underwent root replacement. In-hospital mortality was 7%. Permanent neurological deficits occurred in 5%, transient neurological deficits occurred in 2%. Median SACP time was 24 min. Univariate analysis revealed femoral cannulation site (OR: 3.4; CI: 1.25-9.22, P = 0.016) as well as HCA ≥ 40 min (OR: 4.21; CI: 1.83-12.58, P = 0.001) as predictors of serious adverse events (mortality, neurological injury).

Conclusions: Summarizing, elective aortic arch surgery in elderly patients using SACP and moderate HCA provides excellent results regarding mortality and postoperative neurological outcome. Prolonged HCA time and femoral cannulation were the only predictors of serious adverse events (mortality, neurological injury).